Basic Information
| Provider Information | |||||||||
| NPI: | 1831456268 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMENS RECOVERY ASSOC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 CHAPIN AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503486603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 CHAPIN AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503486603 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 04/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | CECCATO | ||||||||
| AuthorizedOfficialFirstName: | KENDRA | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENTAIL SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 6503478808 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 380011BN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.